Nebraska Medical

Medicare of Nebraska      

  • Direct- WPS Part B J5 MAC
  • Needs to be entered in Claimstaker
  • Vendor Submitter ID: 17680
  • Payer ID – 05402
  • Fax to WPS Medicare EDI at 608-223-3824
  • Attach Cover Sheet- attention to EDI Department
  • Approval Time- 10 Business days

Medicare Enrollment Form

Change of Submitter Form

ERA Enrollment Form

Medicaid of Nebraska      

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SKNE0
  • Submitter ID- 4056 TP#89

Medicaid Enrollment Form

BCBS of Nebraska    

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SB760

BCBS Enrollment Form

Nebraska Medical Mutual of Omaha Medicare (Mutual of Omaha Medicare Nebraska)

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – 52280

Mutual of Omaha Enrollment Form

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region D)
  • ASHN

National Enrollment Forms